Provider Demographics
NPI:1780887711
Name:DR. BILL L EVANS, OPTOMETRIC PHYSICIAN INC., P.C.
Entity type:Organization
Organization Name:DR. BILL L EVANS, OPTOMETRIC PHYSICIAN INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-889-3492
Mailing Address - Street 1:100 E 2ND ST
Mailing Address - Street 2:P.O. BOX 386
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-2406
Mailing Address - Country:US
Mailing Address - Phone:580-889-3492
Mailing Address - Fax:580-889-3499
Practice Address - Street 1:100 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2406
Practice Address - Country:US
Practice Address - Phone:580-889-3492
Practice Address - Fax:580-889-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1780887711332B00000X
OK152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763170AMedicaid
OK=========001OtherBLUECROSS BLUESHIELD
OK0242840001Medicare NSC
OK=========001OtherBLUECROSS BLUESHIELD